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Advance Directives

Preventing unnecessary heartache and turmoil for families.

When he began suffering memory lapses from dementia, Jorge Gomez decided that if he were ever unable to eat or breathe on his own, he’d want no artificial means of nutrition or respiration. His second wife, on the other hand, wanted to do everything medically possible to prolong his life.

So when Gomez couldn’t swallow properly at age 91, there could have been great family discord. Instead, doctors refrained from intubation because Gomez had filled out advance directives—documents that specify your wishes for health care if you become unable to make your own decisions. His appointed health care surrogate, his son, Dr. Domingo Gomez, ensured his father’s instructions were followed, in spite of his stepmother’s desires. As a result, says Domingo, “My father died with dignity, exactly the way he wanted.”

People generally execute advance directives to avoid prolonging the dying process and to prevent unnecessary heartache and turmoil for families. But Domingo Gomez, who is a physician who treats primarily older patients, says many Latinos hesitate to prepare them because they fear they’ll be denied medical care even if their condition is curable. Other people are superstitious, he says, thinking that by planning for their death in this way, they could in fact be bringing death closer. Yet experts agree that advance directives ensure you have a say in your medical treatment, bringing dignity to the dying process.

How to Prepare

The first formal step in making your wishes known is drawing up a living will. Hospice social worker Yohandre Suarez, of VITAS Healthcare Corporation, who teaches a class on advance directives, says, “You can specify whether you want resuscitation and intubation, antibiotics, hydration, blood transfusions, [and] feeding tubes.” You have a full spectrum of options—your directive can state that you want everything done or that you want to limit medical interventions.

Step two, he says, is appointing a health care agent or surrogate to make decisions on your behalf—via a health care power of attorney—who will use your advance directives as a guide to what decisions you would make if you could. In some states, living wills and health care powers of attorney are combined into one document. It’s important to select a surrogate who knows what you want but will weigh the pros and cons before making a choice.

Even though laws differ from state to state, if the patient’s advance directives are properly executed, the appointed person has the legal authority to make health care decisions for the patient, based on the patient’s wishes, says New York-based trusts and estates attorney Sandra M. Rodriguez-Diaz.

Never Too Young

Since a vegetative state or other severe impairment can be brought on by an accident as well as a physical or mental illness, you’re never too young to get your advance directives in order.

"You’re really looking at a question of quality versus quantity. If you’re alive for years in a bed like Schiavo, you’re alive, but are you living?” says Suarez, referring to Terri Schiavo, who didn’t have advance directives when she lapsed into a coma at age 26. Her husband fought all the way to the U.S. Supreme Court for the right to carry out her wishes, which she had expressed to him but never put in writing. Schiavo died in 2005.

To ensure the documents are drafted and executed in a legally binding manner, Rodriguez-Diaz suggests people seek the assistance of an attorney, specifically one specializing in elder law or trusts and estates.

What to include in advance directives may be confusing to the 68 percent of Latinos who identify themselves as Catholic, since the Roman Catholic Church prohibits stopping basic care, including hydration and nutrition. “We can allow a person to die when the end is coming, but we may not kill a person,” says the Rev. Alfred Cioffi, an ethicist at the National Catholic Bioethics Center. He helped the Florida Catholic Conference create the Catholic Declaration on Life and Death, advance directives in English and Spanish that blend the functions of a living will and health care power of attorney, taking into account Catholic doctrine. “Anyone can download that document and maybe just make minor adjustments according to particular state law,” the priest says.

Communicating Your Wishes

Once your advance directives are in order, make sure to give copies to your doctors, surrogate, attorney, and family, and take the papers with you when you go to the hospital. It’s best to communicate in advance with relatives and medical providers about these difficult issues to avoid conflicts later and to give others peace of mind. Under federal law, medical facilities must also inform patients upon admission that they have the right to make advance directives and have them respected. Most experts agree, however, that it’s better to contemplate end-of-life issues in your living room, not the emergency room.

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